Models Addressing Breastfeeding
Exclusive breastfeeding for the first six
months of life, and continued breastfeeding with supplemental foods for at least the first year of a
child's life, is the best possible nutrition for infants, according to the American Academy of Pediatricians.
Women also benefit
from breastfeeding. Women who breastfeed have lower chances of developing multiple chronic diseases,
including premenopausal breast cancer, ovarian cancer, weight gain, diabetes, and metabolic syndrome.
Women in rural areas are less likely to initiate
breastfeeding than women in urban areas. Community breastfeeding support groups are often held at
community centers, clinics, or hospitals.
However, in-person support groups are not available in all rural communities. There is strong evidence that programs
that promote breastfeeding increase initiation and duration of breastfeeding.
One emerging, innovative effort to help women in rural areas breastfeed is telelactation. This intervention is typically
delivered through a mobile device application and offers on-demand consultations with certified lactation
experts who provide breastfeeding guidance and educational materials to mothers. Support may
also be available through traditional phone calls, video chats, text messages, or online
communities. Telelactation also connects breastfeeding women to each other, which leads to the organic
development of virtual support groups. These emerging programs have partnered with WIC agencies, research institutions, and community
coalitions to fund and deliver care.
The Special Supplemental Nutrition Program for Women, Infants, and
Children (WIC) is a resource for breastfeeding support for mothers who are income-eligible to receive
services. WIC provides peer
counseling services, which is support provided by peers, such as a community health worker. There is
evidence that peer counseling programs are effective at increasing initiation rates and
duration of breastfeeding.
Some state WIC programs have also implemented digital tools to support breastfeeding, including 24/7
breastfeeding support via video
calls and text support
programs, both of which have been well received and address geographic barriers.
Human milk banks are facilities around the country that collect, screen,
process, and dispense breast milk. The breast milk comes from lactating
mothers who are eligible to donate their breast milk. Premature or other eligible special needs babies
who have circumstances that do not allow the mother to provide breast milk may be eligible to receive a prescription for donor breast milk.
Healthy, full-term babies often do not qualify for prescriptions, as donor milk is available in limited
quantities and expensive ($3-$5 per ounce). While
insurance companies rarely cover this, milk banks will often work with the family to obtain coverage for the
processing fees of the milk. Medicaid
in some states also covers the costs associated with donor breast milk.
Examples of Models Addressing Breastfeeding
For more information on breastfeeding, visit the First
Year of Life and Breastfeeding section of the Rural Early Childhood Health Promotion Toolkit.
Program Clearinghouse Examples
Considerations for Implementation
There is strong evidence that paid
family leave can increase breastfeeding initiation and duration. A lack of maternity leave is a major
barrier to breastfeeding. There is some evidence that workplace
supports for breastfeeding may increase the likelihood of women exclusively breastfeeding for six months
after birth. Workplace supports differ between employers, but may include enabling access to lactation rooms,
sufficient breaks to nurse or express milk, telework, babies at work, extended maternity leave, or flexible
schedule options. One study found
that in rural areas, many employers do not offer sufficient space or breaktime for mothers to breastfeed.
As discussed earlier, evidence indicates that peer support programs increase breastfeeding rates. However,
implementing peer programs in rural communities may require additional
resources. Purchasing cell phones for peer counselors may be necessary, for example, so the counselors
do not need to use their personal phone plans to communicate with clients. Another possible adaptation to
account for distance would be purchasing laptops and developing a web-based interface so peer counselors could
work at home or the client's home and still allow their supervisor to monitor the interactions.
to breastfeeding faced by rural women include: lack of access to information and education about
breastfeeding, lack of support services, and geographic and social isolation.
Resources to Learn More
The Academy of Lactation Policy and Practice (ALPP)
A national organization offering a certification program promoting evidence-based knowledge and clinical care on
breastfeeding and human lactation for a variety of professionals working with families to promote and support
breastfeeding. Includes a searchable registry by state and ZIP code of certified lactation counselors.
Organization(s): Academy of Lactation Policy and Practice, Inc. (ALPP)
in the Community: Program Implementation Guide: Reducing Disparities in Breastfeeding through Peer and
Professional Support, 2014-2018
Offers resources and guidance to help local health departments and community-based organizations develop,
implement, and sustain evidence-based peer and professional lactation support programs.
Organization(s): National Association of County and City Health Officials (NACCHO)
Breastfeeding Resources for
Child Health and Disability Prevention (CHDP)
Offers a variety of recommendations and clinical guidelines for healthcare providers when helping mothers and
their babies with breastfeeding. Includes a list of county resources in California.
Organization(s): California Department of Health Care Services
Breastfeeding Counselors (IBC) Certification
An introductory lactation education course developed and designed by Natives for counselors providing
breastfeeding support to Native families.
Organization: Center for Health Equity, Education, & Research (CHEER)